Endocrine Abstracts (2018) 57 018 | DOI: 10.1530/endoabs.57.018

Peripheral arterial disease and neuroischemic ulcers in diabetic Charcot foot: a criminal conspiracy?

L Orioli1, F Hammer2, B Vande Berg2, D Putineau3, D Maiter1 & B Vandeleene1


1Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, UCL, Brussel, Belgium; 2Department of Medical Imaging, Cliniques Universitaires Saint-Luc, UCL, Brussel, Belgium; 3Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, UCL, Brussel, Belgium.


Aims: The aims of our study were to compare 1) the prevalence of peripheral arterial disease (PAD) and neuroischemic foot ulcers (NFU) in diabetic patients with and without Charcot foot (CF), 2) the characteristics of PAD in these 2 groups, 3) the major outcomes of NFU including the one year limb salvage rate and one year survival rate in patients with and without CF.

Methods: We retrospectively reviewed the medical records of 172 diabetic patients hospitalized in our unit between 2010 and 2014 for diabetic foot problems, identified using the ICD-9-CM classification. The CF group included 56 patients and the diabetic foot (DF) group included 116 patients.

Main Results: Patients in the CF group were younger (61±10 years vs 65±11 years, P 0.01), had a higher BMI (31±7 kg vs 28±5 kg) and reported more often alcohol abuse than those in the DF group (46.4% vs 19.8%, P <0.001). The prevalence of PAD (66.1% vs 66.4%, P 0.97) and neuroischemic FU (69.5% vs 65.8%, P 0.73) were similar between the groups. PAD mostly affected the infrapopliteal arteries alone in the CF group (59.4% vs 26.7%, P 0.005) and both the infrapopliteal arteries and the femoral axis in the DF group (34.4% vs 65.3%, P 0.005). The need for revascularization was lower in the CF group (34.4% vs 78.7%, P <0.001). The one year limb salvage rate was similar between the groups (90.6% vs 89.3%, P 0.96) while the one year survival rate was lower in the CF group (93.8% vs 100.0%, P 0.03).

Conclusions: Clinicians should no longer consider CF as free from PAD and NFU despite their association is rarely reported. Interestingly, PAD in CF has specificities as it seems less severe and mostly involves the infrapopliteal arteries alone. The prognosis of NFU is poorer in patients with CF whose one year survival rate was lower. Thus, while NFU and PAD are excessively common in diabetic patients, their association with CF remains silent such as a criminal conspiracy, potentially harmful for both the limb and the patient.

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